So I had my follow-up with my knee doctor today. He’s actually my knee and hip and foot and part-time shoulder doctor. But right now he’s just my knee doctor.

I really like this guy. Not only is he a good doctor, but he listens to his patients and treats them as whole patients, not just a knee or a hip that needs to be fixed.

In our last episode of this adventure, I had been taking physical therapy 3X a week to see if could resolve some issues with my left knee prior to a vacation I’m taking in mid-May. If the therapy and at-home work didn’t resolve the problem enough, we were going to look at surgery.

So I’ve completed formal therapy and there’s been a definite improvement, but I don’t know if it’s enough. After discussing all this with my doctor and looking at schedules, we’ve decided I’ve got a month for a go/no go decision on surgery. I’m going to continue my exercises (and more physical therapy if I want it) and see where we are then. (I’ve used up about 1/2 of my physical therapy sessions as allowed by my insurance, and it’s only February, so I’m a bit loathe to use them all up now.)

The other thing he did was inject my knee, which I wasn’t expecting. As many times as I’ve a steroid injection, you’d think that I’d quit being such a sissy about it. However, I have a strong vasovagal reflex and, for some reason, steroid shots are one of the triggers. It really stresses me out. So usually after I get a steroid shot, I go home, prop up in bed, watch old movies and feel sorry for myself. Not so today. I have a full afternoon of stuff at the office.

Next week, however, I’m getting a “deep” steroid shot in my right shoulder — the one I’m told they’re going to have to replace one of these days. I have definitely scheduled the afternoon out of the office! I also get my next set of labs done for my rheumy and that’s also my Orencia shot day, so I’m going to feel like a blooming pin cushion.

So I guess for now, we’ll wait (and do our exercises) and see what another month brings …

There is the old joke about the girl who said to her date, “Don’t … Stop”, so he didn’t.

I have to admit that I’m not usually surprised during doctor’s visits. I’ve been going to most of my doctors for a number of years now and we’ve come to know each other and our routines pretty well. However, I was surprised during my visit to my orthopedic surgeon last week.

I like my orthopedic surgeon. Actually, I like both of my orthopedic surgeons. This one happens to work primarily on the hips to the feet while the other one specializes in shoulders.

My knee had been bothering me for a while and I was in for a consult and hopefully a steroid injection to see if that would help. All that went swimmingly.

And even though he’s into orthopedics, my doctor also treats me as a whole person/patient and has a particular interest in my RA — since RA damages my joints and may involve him in future surgical work. He asked what medications I was on for the RA and, after I’d given him the litany, he nodded approvingly and said, “Well, it sounds like you’re on the big guns.” He went on to comment that as much as my knee was hurting now, he couldn’t imagine what my joints would be like if I quit the medication and cautioned me not to stop.

That gave me pause.

If you’ve been following my blog, you know that I’ve posted a couple of times about how much medication I take and expressed concern about the long-term effects of the drugs. I’ve also wondered if the drugs might be losing their effectiveness as my RA symptoms seem to have been getting worse lately. I guess I never thought about the fact that the drugs might be doing their job as much as they can, but that the RA might be increasing. And while I had fleeting fantasies of taking a drug vacation, my doctor made me realize that I very probably would be asking for serious consequences by doing so.

(You’d think I’d learn. In 2008, after my hip replacement surgery, I went off the drugs and less than six months later had to have my shoulder replaced.)

My doctor went on to comment that medically he wouldn’t offer any suggestions for changes, that he was satisfied that my rheumy had me on a good treatment program. I know him well enough that if he did have a suggestion, he would discuss it with me — including his reasons for suggesting it — and then send a note directly to my rheumatologist with his recommendations for her consideration. (Although he cares enough about me as a patient to take an active interest in my overall care, he wouldn’t cross the boundaries of directly altering another doctor’s prescribed course.)

Take lawyers. You send them something to review, they’re going to make changes, if nothing else, simply to justify their hourly charges. I think that some doctors are like that. You go see them with a problem and they feel obligated to prescribe something. I like it that my orthopedic guy cares enough to consider the situation and give his opinion, but doesn’t order drugs or treatments just because.

So, as much as I fantasize about telling my rheumatologist that I want off the drugs when I see her in a few weeks, I’m going to take my orthopedic surgeon’s advice and don’t stop.

It will be a few days before I post again, so I thought I’d do a quick catch up on miscellaneous items.

I go in today for my annual hip replacement check up. I’m going to have the doc look at my knees at the same time. We took X-rays a year ago and as much as they’ve been bothering me, I want to see if there have been any changes.

I go to Seattle (and back) Monday. Ten hours on a plane on my wedding anniversary! I should get gold stars.

Tuesday morning I go in for my annual physical. We’ll see what my doc has to say about the rapid heart rate. Some of you may remember how excited I was when my ankles reappeared after I started Enbrel. Well, they’ve disappeared almost completely again. I don’t know if this RA related or something to do with the rapid heart rate I’ve been experiencing. I went to one of those online symptom checkers and put in rapid heart rate, swollen ankles, and fatigue and it came up with as its first choice, congestive heart failure. I don’t think that’s it, but it does make one wonder.

Tuesday I also get my car out of the shop. A piece of road debris flew up and hit the rear, drivers’ side door and put about a 2″ scratch in the door. The problem is, it took the paint off all the way to the metal, so I really don’t have a choice but to have it fixed. Not to complain about the cost of owning a nice car, but the price to have that 2″ scratch fixed has a comma in it.

Yesterday I went through the first step of getting a crown replaced. One of the root canals I had last December was in a tooth that already had a crown, which was over 20 years old, so I’ve wound up having to have it replaced.

This Sunday is NASCAR racing at Texas Motor Speedway, so assuming that it doesn’t get rained out, you’ll know where I’ll be spending my Sunday.

And finally, some great news. My nephew and his wife just found out they’re pregnant. He deploys to Afghanistan in a couple of weeks, so I’m really thrilled for them.

I hope your weekend (and early next week) are great. I’ll post an update after I get back from Seattle and I see my doctor on Tuesday morning. Thanks for checking in.

I’ve been waxing somewhat philosophic lately in my posts and I was reminded that I hadn’t given a progress update in a while. So for those of you who interested in hip and/or shoulder replacement, this blog’s for you.

It’s been about 14 months since the hip replacement and I honestly forget that I ever had the surgery done. It feels so much a part of me that I have to consciously remind myself that I’m not supposed to do certain things — like cross my legs. Since I’ve been exercising lately, I’ve noticed a little soreness, but that’s standard workout muscle stuff. I don’t have a limp, loss of strength or motion. The only thing that is any indication that I ever had any surgery on that hip is the scar, and it’s fading.

The shoulder is a different story.

I continue to struggle with both strength and range of motion with the shoulder. I’m pleasantly surprised that my water aerobics classes haven’t made the shoulder sore, in fact, just the opposite. However, I can barely raise my arm above shoulder height. Even the physical therapist wasn’t able to loosen the shoulder up much, so I anticipate that I may be back in surgery next spring to relieve some of the scar tissue. The shoulder is getting stronger, but I can tell that it’s not as strong as my right shoulder. Hopefully continued exercise will improve that situation. I don’t want to sound bleak, because it’s not. It’s better than when I went in for surgery, so that’s an improvement. And in my day-to-day pretty sedentary life, it’s much like my hip in that I forget that I had surgery. It’s those occasions when I try to reach the top cupboard or reach out the car window for the parking ticket or the ATM receipt that I have issues.

In short, I would say that both procedures were a success and while I suspect the hip is stable, that I expect to see continued improvement over the next several months with the shoulder.

Over the last couple of days, I’ve seen Dr. Tucker my hip doctor, and Dr. Banerje, my rheumatologist.

I went to see Dr. Tucker because my hip had been bothering me a bit after a fall and I wanted to check it. Also my knees have been giving me a lot of problems and I wanted to see if there had been any arthritic changes in them since the last time we looked. The answer was “no” to both questions. The hip looks great on the X-Ray as do the knees. However, as Dr. Tucker pointed out, the pain and stiffness is due to the RA, which attacks the soft tissues and doesn’t show up on the Xrays.

Which brings us to Dr. Banerje. Bottom line is that she’s left me on Humira, but added some dreaded prednisone. I’m take two 5-mg tablets a day for two weeks, then dropping to one per day until I see her again in a few weeks. She also drained some fluid out of my right knee and shot it full of steroids. This was not a pleasant procedure. Then I had to get my labs done and the girl had to stick both arms to get enough blood. Also not pleasant. I went home and felt sorry for myself for the rest of the day.

In much more pleasant news, I guess, I’m taking delivery of my new Lexus IS 250 this evening. I’m trading in my much-loved SmartCar for something more substantial, with more power, and more air bags. Jack’s just worried about me driving such a small car in Dallas rush-hour traffic. He does have a point, but the SmartCar is one of those pure joys in my life that make me smile every day, and those are few and far between. I’m probably the only person in America who’s not just absolutely thrilled to be driving home in a new Lexus. Poor me.

On yet another topic, I may have to go to South Africa for a couple of weeks on business. I’m looking forward to the trip, but I’m not sure what that will do to my medication schedule. I don’t think I can travel that far away for that long with my Humira.

Much like my hip surgery, I tend to gauge my recovery by how well I can do things by myself. Now that I’ve started back to work, I’m driving and wearing “big girl” clothes, so I have a whole new list of things I’m [supposed] to be doing by myself.

Getting dressed [and undressed] has still got to be my biggest issue. I occasionally “get stuck” pulling a top on or off. Other types of clothes that need to be pulled on or adjusted with both hands are a problem since I don’t have any “pulling power” in my left arm yet.

Blow drying my hair is a daily adventure. My ultra-short haircut has now grown out to a little over an inch on top. On the weekends I can just towel-dry and go. However, during the week I actually have to dry it because if I don’t it’s still wet when I get to the office. I had this really neat hair dryer stand that was basically a long goose-neck stand with a clamp on the end that held the hair dryer. That worked great for exactly three days until my cleaning lady picked it up by the hairdryer and broke off the clamp. The process is three parts. The first is me waving the hairdryer around with my right hand, stopping and styling the hair, repeating as necessary. The second is me propping my left arm up on the sink and holding the hair dryer while waving my head wildly around trying to style with my right hand. The third is my husband doing his G.I. Joe imitation with his Kung Fu grip holding the hairdryer, which allows me to style with my right hand. None of this works very successfully, but as short as my hair is, it’s styled straight back, so there’s not a lot of damage that can be done. In another couple of weeks, though, my hair will be long enough that I’m going to have to do something with it.

Driving is the other exciting part of my day. Driving in Dallas is an adventure in living even if you have both arms available. Driving with 1.5 hands is really exciting. I’m to the point that I can hold the steering wheel with the left hand, although I do all the hard steering (turns, etc.) with my right arm. I also have to use my right hand to use the turn signal. Normally I’m driving alone, but this weekend I was test driving new cars and I think the car dealer thought I was a bit weird the way I was driving. Can’t say that I blame him.

So, I’m getting there. It’s a slow progress and I occasionally forget that I can’t do things — like open doors with my left arm and I am quickly reminded. I cooked dinner last week and getting things in and out of the oven was pretty scary. I also cracked open an acorn squash one handed with a large chef’s knife and it’s a wonder I didn’t chop more than the gourd.

Tomorrow I see Dr. Tucker (the ortho guy who did my hip) and my rheumatologist. My hip has been bothering me since my fall and my knee is making me miserable, so we’ll see what he says. This is my check up with my rheumatologist. The Humira hasn’t kicked in completely since the surgery and I am still having some problems, but not as much as when I was off because of surgery.

Well yesterday I saw my internist for my pre-op physical and general annual check up. No surprises there unless something comes back in the blood work.

This morning I went in for a follow-up visit with my rheumatologist. She was appalled that I’ve been off the Humira as long as I have. Ideally she wants her patients to be off for four (4) weeks before surgery then start again two (2) weeks after surgery if everything is healing and progressing like it should.

She was also concerned that Dr. Cheatum prescribed two Celebrex a day. She said I should be stopping the Celebrex any day now prior to the surgery and when I start back up again after surgery, she wants me to only take one. In the meantime she has prescribed some pain medication for me to take when I get of the Celebrex that won’t interfere with any of the surgery stuff. I don’t know that I’ll take it. I’ll probably stick with Tylenol. I have too much to get done to be dopey headed. But if I have problems sleeping or whatever, it’ll be nice to have them.

I think I mentioned in an earlier post that my knees have been bothering me. When she examined me today, it was apparent that my right knee was swollen. She wanted to draw off some of the fluid then inject the knee. NOT! I guess it would have made my knee feel better over all, but I don’t have the time to deal with it if it hurts due to the procedure. She offered to let me come in at any time before surgery and get my joint(s) injected and/or put me on a low dose of prednisone, although she’s not real keen on the prednisone because it can interfere with healing. She’s afraid that I’ll have a flare being off the Humira and I don’t doubt that she’s right.

I still haven’t gotten my head around this surgery. I know without a doubt that this is the right answer, but knowing and feeling it are two different things. They had to stick both arms yesterday just to do a simple blood draw for my physical. That just brings home how difficult it is to get an IV started in me and all those fears about the surgery came flooding back.

I called the surgeon’s office today because I haven’t gotten the disability paper work back so I can get paid while I’m off. They’re going to get it to me later today (probably). I still haven’t gotten my packet of information about the surgery and check-in procedures, so hopefully that will show up soon.

Tomorrow I go to Houston all day on business, so I’ll get to beep through two new airports — Dallas Love and Houston Hobby. I can’t imagine how many bells I’ll set off when I have both the shoulder and the hip.

I expect things to be pretty quiet between now and surgery, but if anything new pops up, I’ll update the blog.

I haven’t posted for a while because things have been either too hectic or so quiet that there hasn’t been much to say. However there have been some new developments on the health front that are worth sharing.

After my hip surgery, I noted that my left shoulder was bothering me. I had surgery on that shoulder in the fall of 2007, but that seemed to solve the problem. I assumed that the issues were because I was using my upper body more for mobility — getting out of bed and using my walker then my cane (with my left hand). However, after a reasonable time when I quit doing those things had passed, I noticed that not only was my shoulder not getting better, that I was continuing to lose mobility. I can’t raise my arm above shoulder height and it’s painful to reach very far in any direction. Driving and getting dressed in the morning are adventures every day. Considering the fact that I’m also not supposed to bend at the hip more than 100 degrees or cross my right leg past my midline (which means I have to be very creative to tie my shoes), mornings don’t start as well as they used to for me.

At any rate, I went to see Dr. Tucker my orthopedic surgeon for my final hip check out in December and mentioned the shoulder issue. So he sent me for an MRI the Saturday before Christmas. I spent the period between Christmas and New Year’s shutting down and moving out of my consulting office as I accepted a job with one of my clients — so I was packing boxes and schlepping things around with my sore shoulder. My follow-up visit with Dr. Tucker was on New Year’s Eve. I truly expected the MRI to come back perfectly normal — simply because all my MRI’s come back normal. This one didn’t. They found several small tears in the rotator cuff, tendonitis, and increased arthiritic activity from my MRI I’d had the year before when I had surgery. Ouch! No wonder my shoulder hurt. After discussing the various options, Dr. Tucker injected my shoulder, hoping that would calm down the tendonitis and arthritis.

You know, there are a lot of things you can do on New Year’s Eve — especially in Dallas. If anyone offers you the option to have your shoulder injected, don’t take them up on it. I probably would have waited, but it was New Year’s Eve and I new insurance with my new employer starting on New Year’s Day, but I hadn’t yet received an insurance card. Plus I’d more than settled my 2008 deductible, so I felt like I should get all the good I could out of that situation.

The fact that I had increased arthritis in my shoulder, plus the fact my knees have been killing me and I’d been having increasing stiffness in the morning, basically told me I probably shouldn’t have gotten off the MTX, so I made an appointment to see my rheumatologist.

I won’t bore the reader with the details of that particular office visit. Let it be suffice to say that my appointment was at 11:00 am and I finally got to see the doctor at 3:45. I really like Dr. Cheatum, but his scheduling / office procedures are not patient friendly in any sense of the word.

The net result is that starting this week, I’ll be on Humira. There are a lot of personal lifestyle reasons that I made the switch. The terrible fatigue I experienced with MTX every week after taking it apparently isn’t as much of a side effect with Humira. And you do an injection with Humira every other week whereas you have to take MTX every week, so even if there are some short-term effects, I’ll only have them half as often.

I did some research on the injection. I am using the pre-loaded pen rather than the pre-filled syringes. I don’t like to watch myself get poked when someone else does it and when I had to give myself a shot of Lovenox every day for two weeks after hip surgery, I really hated it. The shot itself was nothing, but it was all I could do to watch myself slide that needle into my skin. At least with the pen, all I have to do is punch the trigger and it does everything for me.

The bad news is is that the injection is supposedly extremely painful. I’ve heard both sides of the story — the injection is easier so you can control it, no the pen’s easier because its automatic. I did pick up a few tips to make things easier. Humira has to be refrigerated and apparently letting it come to room temperature helps keep it from stinging. Icing the injection site to numb it seems to help some people as well. You can do the injection in your stomach or the top of your thighs and apparently the stomach is easier because it has more flab.

Wednesday night I’ll find out the truth. Without going into too much detail on why I picked Wednesday, let’s just say that traveling through airport security with an icepack and a weird looking device, then figuring out how to refrigerate the pen until I’m supposed to use it while I’m traveling can be very complicated. Looking at my travel schedule between now and the end of the year, I don’t see any travel happening on Wednesday night at all.

A couple other notes about Humira for those with RA that read this blog. It can be very expensive. My four-week supply of two pens was about $1570 before insurance kicked in. It covered all but the $25 co-pay and the company that makes Humira will give you a card that helps pay up to $325 per prescription, so that helps. My prescription wound up not costing me anything. (On the other hand, the insurance company is being stubborn about paying for my Celebrex prescription. The mobic that I’m on has started bothering my stomach, so Dr. Cheatum switched me. The pharmacy was going to give me 1 month’s worth, but it was $270, so I told them to wait until we could get this straightened out. I can stay on Mobic for another week or so until we get things taken care of.)

The other thing is that while officially you’re not supposed to feel the effects of Humira for about 3 months, many people start feeling better almost immediately, so I’m hopeful that it will help my shoulder and the other pieces and parts that are getting squeaky.

One of the things that concerns me is that Humira severely depresses the immune system. A virus that gives a normal person the sniffles could very well hospitalize me or worse. And if I have surgery or anything like that I have to stop Humira. So if Dr. Tucker decides we need to fix those tears in my rotator cuff, I’ll have to stop the medicine almost as soon as I started it.

A final word about the other side effects for those of you who are interested. It increases your chance for certain kinds of cancer (particularly some of the skin cancers) by up to 3 times. It also makes you very susceptible to fungal infections — like histoplasmosis which can kill you. It’s not a very pleasant drug and its new enough that the long-term side effects aren’t yet fully understood.

I’ve already tried NOT taking any of the drugs and, based on the shape my shoulder is in, that’s not a good idea. But I’ll take quality of life any day over quantity of life and Humira has the potential to do that.

I’ll post more after my injection on Wednesday. Thanks for checking in.

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